If you are preparing for robotic prostate surgery, you may be wondering what happens to your bladder once the prostate has been removed. Your bladder stays in place. Instead, your surgeon reconnects it directly to the remaining urethra so you can continue to pass urine normally after healing.
A temporary catheter helps drain urine while this new connection heals. When the catheter is removed, you may notice some leakage, urgency or changes in bladder control at first, but these commonly improve as your tissues recover and your urinary system adapts.
Is Your Bladder Removed During Robotic Prostate Surgery?
No. During robot-assisted radical prostatectomy for prostate cancer, your prostate is removed but your bladder remains in place. Your surgeon separates the bladder from the prostate, removes the gland and then reconnects your bladder to the remaining urethra.
This creates a temporary gap that needs to be repaired so you can urinate through your normal route again. The reconstruction does not involve an artificial bladder or permanent urinary diversion, which can be reassuring if you are concerned about how your urinary system will work after surgery.
Why Does Removing the Prostate Affect the Bladder?
Your prostate forms part of the normal connection between your bladder and urethra, so removing it means these structures need to be joined directly. Your surgeon brings your bladder down towards the remaining urethra and creates a new connection, allowing urine to continue passing through your normal urinary route.
Your bladder can adapt to this change, so you do not usually feel that it has been moved once healing is complete. However, the tissues around your bladder outlet, urinary sphincter and pelvic floor are affected by surgery, which can temporarily change your bladder control and urinary sensations during recovery.
What Happens to the Bladder Neck?
Your bladder neck is the opening at the bottom of your bladder where it connects to the prostate. During robotic radical prostatectomy, your surgeon carefully separates the bladder neck from the prostate and, when your cancer and anatomy allow, may preserve as much of the natural tissue as possible.
The bladder neck plays a smaller role in urinary continence than your external urethral sphincter, but preserving it in suitable patients can support continence recovery. Your surgeon will always prioritise complete cancer removal, and factors such as a large prostate, prominent median lobe or previous TURP can make bladder-neck preservation more difficult.
Does the Bladder Need to Be Reconstructed?
Sometimes, your bladder neck may need some reconstruction before it can be connected to the remaining urethra. After your prostate is removed, the bladder opening may be wider than the urethra, so your surgeon can reshape the bladder neck to create a suitable connection.
The amount of reconstruction varies depending on your anatomy and previous procedures. Having a large prostate, prominent median lobe or previous surgery such as TURP or HoLEP can affect the bladder-neck area, so reconstruction is not necessarily a complication but may simply be a necessary step for a secure urinary connection.
How Is the Bladder Reconnected to the Urethra?
After your prostate has been removed, your surgeon brings your bladder neck down towards the remaining urethra and stitches them together. This new connection is called a vesicourethral anastomosis, which simply means a surgically created join between your bladder and urethra.
The aim is to create a precise, watertight and tension-free connection that can heal properly. Your surgeon may use different stitching techniques, but the important goal for you is a secure join that allows urine to flow normally after recovery.
Does the Bladder Sit Lower After the Prostate Is Removed?
Your bladder is brought down slightly towards the remaining urethra after your prostate is removed. This is necessary because the prostate previously occupied the space between your bladder and the lower part of your urethra, so your surgeon needs to bring these structures together and reconnect them.
You are unlikely to feel that your bladder is sitting in a different position once you have healed. During recovery, you may instead notice changes in urinary control, urgency or frequency as your bladder, sphincter and surrounding tissues adapt.
Why Is a Catheter Put Into the Bladder?
A urinary catheter is temporarily placed in your bladder to drain urine while the new bladder-to-urethra connection heals. The soft tube passes through your penis and urethra into your bladder, where a small balloon keeps it securely in place, allowing urine to drain continuously into a collection bag.
Your catheter also supports the new connection during the early healing period, acting like a temporary stent. You will usually wake up with it in place and may go home with the catheter, with instructions on how to manage the drainage bag until it is removed.
How Long Does the Bladder-to-Urethra Connection Take to Heal?
The bladder-to-urethra connection begins healing during the first week or two, which is why your catheter is usually kept in place during this period. Many patients have their catheter removed around 7–10 days after robotic prostatectomy, although you may need it for up to 14 days or longer depending on your recovery and surgery.
Your tissues continue to heal for several weeks after the catheter is removed, so recovery does not end when the catheter comes out. If you need the catheter for longer, it does not necessarily mean there is a serious problem; your surgeon may simply want to give your connection more time to heal securely.
What Does Your Bladder Do While the Catheter Is In?
Your kidneys continue producing urine normally after prostate surgery, and your bladder continues to collect it. However, because the catheter provides a continuous drainage route, your bladder does not need to fill up before urine leaves your body.
You may experience bladder spasms, which can feel like cramps or a sudden urge to urinate, because your bladder can react to the catheter. Some urine may also leak around the catheter during a spasm, but if urine is still draining into the bag, this does not necessarily mean there is a problem with your new bladder-to-urethra connection.
What Happens When the Catheter Is Removed?
Once your clinical team is satisfied that the new bladder-to-urethra connection has healed sufficiently, your catheter can be removed. You may then be asked to pass urine and have a bladder scan to check that you are emptying your bladder properly.
Your first few attempts at urinating may feel different because your bladder has been continuously drained while the catheter was in place. You may experience frequent urination, urgency or urine leakage at first, but these changes are common during early recovery as your bladder and surrounding tissues adapt.
Common Bladder Changes After Catheter Removal
| Change | What you may notice | What usually happens |
| Urinary leakage | Urine may leak when standing, walking, coughing or sneezing | Often improves gradually as the sphincter and pelvic-floor muscles recover |
| Urgency | A sudden strong need to pass urine | Usually settles as the bladder and surrounding tissues heal |
| Frequency | Needing to urinate more often than before surgery | Often improves over the following weeks |
| Different urinary sensation | Passing urine may initially feel unfamiliar after continuous catheter drainage | Usually becomes more normal as your urinary system adapts |
| Temporary bladder irritation | Mild discomfort or increased sensitivity when urinating | Common early in recovery and generally improves with healing |
| Difficulty emptying | Weak stream or feeling that the bladder is not empty | Persistent or worsening symptoms should be reported to your clinical team |
Why Can Bladder Control Be Poor After Surgery?
Your bladder may still be working normally, but your ability to hold urine can be temporarily reduced after surgery. Removing the prostate affects the muscles, nerves and support structures involved in urinary control, while swelling around the new bladder-to-urethra connection can also make control more difficult.
You may notice leakage when you stand, cough, sneeze, laugh or walk, particularly during the early stages of recovery. For most men, bladder control gradually improves as the tissues heal and your pelvic-floor muscles regain strength.
Does Urinary Leakage Mean the New Bladder Connection Is Leaking?
Usually not. The urine leakage you notice from your penis after the catheter is removed is usually urinary incontinence, which happens because your sphincter and pelvic-floor muscles have not yet regained full control.
A leak from the surgical connection is different because it means urine is escaping from the new bladder-to-urethra join. Needing pads after surgery does not usually mean this connection has failed, as temporary incontinence is common and often improves as your urinary-control muscles recover.
Will Your Bladder Feel Smaller After Surgery?
Your bladder is not normally made smaller during robotic prostate surgery. However, it may temporarily feel as though it holds less while your urinary system recovers.
- More frequent urination: You may need to visit the toilet more often than usual.
- Stronger urgency: Your bladder may feel more sensitive after the catheter is removed.
- Postoperative irritation: Swelling and healing tissues can temporarily affect bladder sensations.
- Smaller voided volumes: Frequent “just in case” trips can mean you pass smaller amounts of urine.
These changes usually improve as your bladder and surrounding tissues settle. Your normal bladder habits can gradually return during recovery.
Can You Experience Urgency and Frequency Afterwards?
Yes. You may experience urgency and frequency after your catheter is removed. Urgency means you suddenly feel that you need to pass urine, while frequency means you need to visit the toilet more often than usual.
These symptoms often settle as your bladder adapts and your tissues heal, although they can sometimes last longer. If your symptoms are getting worse rather than gradually improving, speak to your clinical team so they can check for problems such as a urinary infection.
How Do Pelvic-Floor Exercises Help the Bladder?
Pelvic-floor exercises do not strengthen your bladder itself; they strengthen the muscles that support your urethra and help control urine flow. These muscles become especially important after your prostate has been removed, helping you regain control as your urinary system heals.
You may be taught the correct technique before surgery and advised when to restart the exercises after your catheter is removed. Pelvic-floor training can support earlier continence recovery, particularly during the first few months after surgery.
Evidence Note
How quickly you regain bladder control after prostate surgery depends on more than your bladder alone. Current European guidance identifies preservation of the external urethral sphincter, membranous urethral length and, in suitable patients, the bladder neck as factors that can support recovery.
A 2024 meta-analysis of six studies involving 2,351 patients found better pad-free continence at three months after robotic prostatectomy with bladder-neck preservation, although the difference was not significant at one year. Other evidence reviewed by current European guidance has reported both earlier and longer-term continence benefits, so outcomes can vary between studies and surgical techniques.
Can Scar Tissue Develop Where the Bladder Is Reconnected?
Yes, although significant narrowing is uncommon after modern robotic prostatectomy. Scar tissue can occasionally form around the new bladder-to-urethra connection, causing vesicourethral anastomotic stenosis. Contemporary reviews suggest that vesicourethral anastomotic narrowing occurs in roughly 1–5% of patients after radical prostatectomy, although rates vary between studies and surgical approaches.
You may notice a progressively weaker urine stream, difficulty passing urine or a feeling that your bladder is not emptying fully. If these symptoms develop or worsen, speak to your clinical team, as tests can identify the cause and treatment can usually open the narrowed area if needed.
Can the Bladder Be Injured During Robotic Prostatectomy?
Your surgeon works carefully around your bladder neck during robotic prostatectomy, but significant accidental bladder injury is not expected during routine surgery. Factors such as a large median lobe, previous TURP or HoLEP, scar tissue or cancer close to the prostate base can make this part of the operation more complex.
If an unintended opening or injury occurs, your surgeon can usually identify and repair it during the procedure. Having a catheter afterwards does not mean your bladder was injured; the catheter is routinely used to protect the new bladder-to-urethra connection while it heals.
Will Your Bladder Work Normally in the Long Term?
For many men, bladder storage and emptying settle into a comfortable routine after recovery. The main long-term urinary concern is usually bladder control rather than whether your bladder itself continues to function, and leakage often improves gradually over the months following surgery.
Your age, bladder function before surgery, pelvic-floor strength and the details of your operation can all affect recovery. If you continue to have troublesome leakage or develop difficulty emptying your bladder, speak to your clinical team because treatments are available.
UK Guidance Note
Current NICE guidance recommends that men with troublesome urinary symptoms after prostate cancer treatment have access to specialist continence services. Support can include pelvic-floor muscle re-education, bladder retraining, coping strategies and appropriate medication where needed.
Catheter timing varies between UK centres. Many patients undergoing robotic prostatectomy have the catheter removed around seven to ten days after surgery, while some need it for up to fourteen days or longer depending on the reconstruction and healing. Your own surgical team’s advice should take priority.
What Should You Ask Your Surgeon About Your Bladder?
Before surgery, ask your surgeon how your prostate size, cancer location and previous procedures such as TURP or HoLEP may affect your bladder neck. You can also ask whether they expect to preserve the bladder neck, whether reconstruction may be needed and how your individual anatomy could affect recovery.
It is also useful to ask how long you are likely to have the catheter and what could mean keeping it in for longer. You can ask what level of urine leakage is expected after removal and what support is available if your bladder control takes longer to recover.
Myth vs Fact
| Myth | Fact |
| Your bladder is removed during radical prostatectomy. | No. Your prostate is removed and the bladder is reconnected to the remaining urethra. |
| Urine leakage after catheter removal means the surgical join has failed. | Usually not. Leakage from the penis is commonly temporary urinary incontinence rather than an internal anastomotic leak. |
| Bladder-neck preservation guarantees continence. | No. Bladder-neck preservation can support continence recovery in selected patients, but it cannot guarantee continence. Your sphincter function, urethral length, anatomy and surgical factors also influence recovery. |
| A weak urine stream after surgery is always part of normal recovery. | No. A progressively weaker stream or difficulty emptying can indicate vesicourethral anastomotic stenosis and should be assessed. |
| A catheter that stops draining is normal. | No. If drainage stops, especially with bladder pain or fullness, prompt clinical advice is needed because the catheter may be blocked. |
Key Takeaways
- Your bladder is not removed during robotic radical prostatectomy; it is reconnected directly to the remaining urethra.
- The new bladder-to-urethra connection is called a vesicourethral anastomosis, and a temporary catheter supports it while it heals.
- Catheters are commonly removed around 7–10 days after robotic prostatectomy, although some patients need them for longer.
- Temporary urinary leakage, urgency and frequency can occur after catheter removal as your sphincter, pelvic floor and urinary system recover.
- A progressively weaker urine stream, difficulty emptying your bladder or a catheter that stops draining should be reported promptly.
Frequently Asked Questions
1. Is the bladder removed during robotic prostate surgery?
No, your bladder is not removed during robotic radical prostatectomy. Your prostate is removed and your bladder is then reconnected directly to the remaining urethra so you can continue to pass urine normally.
2. Does your bladder move after prostate removal?
Your bladder is brought slightly downwards so it can be connected to the remaining urethra. Once you have healed, you are unlikely to notice any difference in where your bladder sits.
3. How is the bladder reconnected after robotic prostate surgery?
Your surgeon joins your bladder neck to the remaining urethra using stitches, creating a new connection called a vesicourethral anastomosis. This connection needs to be secure and watertight so it can heal properly.
4. How long do you have a catheter after robotic prostate surgery?
You will usually have a catheter for around 7–10 days, although some men may need it for up to 14 days or longer. Your surgeon will decide when it is safe to remove it based on how your bladder-to-urethra connection is healing.
5. Why do you leak urine after the catheter is removed?
You may temporarily leak urine because the muscles and tissues responsible for urinary control need time to recover after surgery. Leakage when you cough, sneeze, stand or walk is common during early recovery and often improves gradually.
6. Can your bladder feel smaller after prostate surgery?
Your bladder is not normally made smaller during robotic prostatectomy. However, you may temporarily feel as though it holds less because bladder irritation, urgency and frequent urination can occur after the catheter is removed.
7. Can you have bladder spasms with a catheter?
Yes, your bladder can sometimes contract around the catheter, causing cramping, discomfort or a sudden urge to urinate. Some urine may leak around the catheter during a spasm, even when urine is still draining into the collection bag.
8. Can scar tissue form where your bladder and urethra are joined?
Yes. Scar tissue can occasionally narrow the new bladder-to-urethra connection, a condition called vesicourethral anastomotic stenosis. A progressively weaker stream or difficulty emptying your bladder should be assessed.
9. Do pelvic-floor exercises help with bladder control after surgery?
Yes, pelvic-floor exercises can strengthen the muscles that help support your urethra and control urine flow. Your clinical team can advise you when to restart these exercises and make sure you are using the correct technique.
10. Will your bladder work normally after robotic prostate surgery?
For many men, bladder function settles as the tissues heal and the urinary system adapts to the changes caused by surgery. Urinary leakage, urgency and frequency can improve over the following weeks and months, although recovery varies from person to person.
Final Thoughts: Understanding Your Bladder After Prostate Surgery
Your bladder remains in place during robotic prostate surgery, but removing your prostate means your bladder needs to be reconnected to the remaining urethra. A temporary catheter supports this new connection while it heals, and you may experience leakage, urgency or more frequent urination once it is removed. These changes are common during early recovery and often improve as your urinary system adapts.
Your recovery can vary depending on your individual anatomy, bladder function before surgery and the details of your operation. If you are considering robotic prostate surgery in London and would like specialist advice, you can contact our team to discuss your options and arrange a consultation tailored to your individual needs.
References:
- European Association of Urology (2026) EAU Guidelines on Prostate Cancer. EAU Guidelines Office, Arnhem, The Netherlands. Available at: https://uroweb.org/guidelines/prostate-cancer
- National Institute for Health and Care Excellence (2019, updated 2021) Prostate cancer: diagnosis and management. NICE guideline NG131. Available at: https://www.nice.org.uk/guidance/ng131
- University College London Hospitals NHS Foundation Trust (2026) Robotic prostatectomy. Available at: https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/robotic-prostatectomy
- Choi, J. et al. (2024) ‘Effects of bladder neck sparing on continence outcomes of robotic-assisted radical prostatectomy: a systemic review and metaanalysis’, Prostate International, 12(4), pp. 179–185. Available at: https://pubmed.ncbi.nlm.nih.gov/39735194/
- Valovska, M.T., Woodle, T. and Hagedorn, J.C. (2025) ‘Surgical management of vesicourethral anastomotic stenosis’, Investigative and Clinical Urology, 66(5), pp. 383–394. Available at: https://pubmed.ncbi.nlm.nih.gov/40897657/
- Zeng, Y. and Wang, J. (2024) ‘Pelvic floor muscle exercises can effectively improve urinary incontinence after radical prostatectomy: systematic review and meta-analysis based on randomised controlled trials’, Archivos Españoles de Urología, 77(6), pp. 658–665. Available at: https://pubmed.ncbi.nlm.nih.gov/39104234/